CT Scans in Children with Headaches Used Widely in and out of Emergency Department

Sixty-seven percent of children in the United States received their computed tomography (CT) scans outside of the emergency department (ED) setting.

In the United States, more than 25% of the children treated for headache across a range of care settings received a CT imaging scan, possibly exposing them to unnecessary radiation and increased cancer risks, according to new research.

The study’s findings were published in the July 2013 issue of the journal Pediatrics. That providers sometimes use CT scans to rule out brain tumors or brain abnormalities because parents are concerned about this possibility—which is the cause of less than 1% of those with pediatric headache—when overuse of CT scans can increase the risk of brain tumors,” said coauthor Dr. Paul Young, professor of pediatrics at the University of Utah School of Medicine (Salt Lake City, USA) who was one of the individuals designated by the American Academy of Pediatrics (Elk Grove Village, IL, USA to participate in the research. “It’s possible that physicians underestimate the risks associated with CT scans.”

The use of CT scans to diagnose pediatric headache remains high despite increased cancer risks and the fact that except for certain narrow indications, providers often gain little clinically useful information from these imaging studies while exposing children to unnecessary radiation. Headaches are among the five most typical health problems in children, as well as one of the most frequent reasons for pediatric neuroimaging, especially in EDs.

The Pediatrics study found that children who were evaluated in the emergency room were four times more likely to have CT scans than those children who did not go to the emergency room. However, even outside the emergency room, use of CT scans remained widespread. In pediatric patients getting CT scans for headaches, 67% received their scans outside of the emergency department setting.

Other researchers have gathered evidence that CT scans increase a child’s lifetime risk of cancer. A retrospective study published in the Lancet in 2012 suggested that the cumulative radiation from as few as 2 to 3 CT scans in a child younger than 15 years old could triple the risk of brain tumors, while 5 to 10 head scans could triple the risk of leukemia. A study published in the June 2013 edition of JAMA Pediatrics noted that a radiation-induced solid tumor is predicted to result from every 300 to 390 abdomen/pelvis scans in girls.

The Pediatrics study, written by authors either employed by or designated by HealthCore (Wilmington, DE, USA), American Academy of Pediatrics (AAP; Elk Grove Village, IL, USA), American Academy of Family Physicians (AAFP; Leawood, KS, USA), American Academy of Neurology (AAN; Minneapolis, MN, USA), and WellPoint, stemmed from discussions by WellPoint and AAP to find out “to what extent do current practice patterns for treatment of pediatric headache align with practice guidelines?”

An advisory group including representatives from the AAP, AAN, and AAFP helped frame the discussion that resulted in this study. The AAN recommends in favor of MRI scans as opposed to CT imaging for individuals with headache, a normal history, and neurologic examination. This recommendation was endorsed by the American Academy of Pediatrics and the American Colleges of Radiology (Reston, VA, USA).

“We found that AAN imaging guidelines were most often followed by neurologists when treating children, but not by other physicians,” said Dr. Alan Rosenberg, WellPoint vice president of medical and clinical pharmacy policy. “We want to better understand current utilization patterns to help parents of patients, clinicians, and health benefits companies with the information we need to inform and facilitate change to improve care for children and adolescents.”

In 2008, 1.7 million pediatric CT scans were performed in the ED, 6% of all pediatric emergency room visits that year. As many as 28% of those scans were performed for headache unrelated to head injury. Quality improvement initiatives, such as those supported by AAN and advocated in the Choosing Wisely Campaign by the AAP, could significantly reduce pediatric and adolescent exposure to unnecessary radiation.

The retrospective analysis included 15,836 children aged three to 12 years old with more than two medical claims for headache.

Related Links:
University of Utah School of Medicine
American Academy of Pediatrics
HealthCore